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Biomedical subjects

Miodrag Ostojic

Publications and source records attributed to Miodrag Ostojic.

12 recordsLinked to original sources
PubMed2006

Outcome of patients in relation to duration of new-onset atrial fibrillation following acute myocardial infarction.

AIM: The duration of new-onset atrial fibrillation (AF) following the acute myocardial infarction (AMI) was evaluated as well as its relation to in-hospital and 7-year mortality. METHODS AND RESULTS: A total of 320 consecutive patients with AF following AMI were examined and patients with AF <7 h (n = 141) were compared to those with AF > or =7 h in duration (n = 179). Receiver Operating Characteristic analysis was performed to identify the most useful AF duration cut-off level for the prediction of poor outcome. Patients with longer AF duration were older and had more advanced heart failure than patients with short arrhythmia duration. Patients with longer AF duration had worse outcome, including higher in-hospital (22.3 vs. 12.8%) and 7-year (67.4 vs. 34.4%) mortality. After multivariate adjustment, longer AF duration remained an independent predictor of long-term mortality (relative risk = 2.04, 95% confidence interval = 1.39-2.99, p = 0.0002). CONCLUSION: New-onset AF > or =7 h in duration following the AMI independently predicts long-term mortality.

Aged↗
PubMed2006

Comparison of exercise, dobutamine-atropine and dipyridamole-atropine stress echocardiography in detecting coronary artery disease.

BACKGROUND: Dipyridamole and dobutamine stress echocardiography testing are most widely utilized, but their sensitivity remained suboptimal in comparison to routine exercise stress echocardiography. The aim of our study is to compare, head-to-head, exercise, dobutamine and dipyridamole stress echocardiography tests, performed with state-of-the-art protocols in a large scale prospective group of patients. METHODS: Dipyridamole-atropine (Dipatro: 0.84 mg/kg over 10 min i.v. dipyridamole with addition of up to 1 mg of atropine), dobutamine-atropine (Dobatro: up to 40 mcg/kg/min i.v. dobutamine with addition of up to 1 mg of atropine) and exercise (Ex, Bruce) were performed in 166 pts. Of them, 117 pts without resting wall motion abnormalities were enrolled in study (91 male; mean age 54 +/- 10 years; previous non-transmural myocardial infarction in 32 pts, angina pectoris in 69 pts and atypical chest pain in 16 pts). Tests were performed in random sequence, in 3 different days, within 5 day period under identical therapy. All patients underwent coronary angiography. RESULTS: Significant coronary artery disease (CAD; > or =50% diameter stenosis) was present in 69 pts (57 pts 1-vessel CAD, 12 multivessel CAD) and absent in 48 pts. Sensitivity (Sn) was 96%, 93% and 90%, whereas specificity (Sp) was 92%, 92% and 87% for Dobatro, Dipatro and Ex, respectively (p = ns). Concomitant beta blocker therapy did not influence peak rate-pressure product and Sn of Dobatro and Dipatro (p = ns). CONCLUSION: When state-of-the-art protocols are used, dipyridamole and dobutamine stress echocardiography have comparable and high diagnostic accuracy, similar to maximal post-exercise treadmill stress echocardiography.

Atropine↗
PubMed2005

Exercise-induced changes in mitral regurgitation in patients with prior myocardial infarction and left ventricular dysfunction: relation to mitral deformation and left ventricular function and shape.

AIMS: The aim of this study was to assess the relationship between exercise-induced changes in mitral regurgitation (MR) and echocardiographic characteristics of mitral deformation, global left ventricular (LV) function and shape at rest and after exercise. METHODS AND RESULTS: Forty consecutive patients with ischaemic MR due to prior myocardial infarction (MI), ejection fraction <45% in sinus rhythm underwent exercise-echocardiographic testing. Exercise-induced changes in effective regurgitant orifice (ERO) were compared with baseline and exercise-induced changes in mitral deformation and global LV function and shape. There was significant correlation between exercise-induced changes in ERO and changes in coaptation distance (r=0.80, P<0.0001), tenting area (r=0.79, P<0.0001) and mitral annular diameter (r=0.65, P<0.0001), as well as in end-systolic sphericity index (r=-0.50, P=0.001, respectively), and wall motion score index (r=0.44, P=0.004). In contrast, exercise-induced changes in ERO were not related to the echocardiographic features at rest. By stepwise multiple regression model, the exercise-induced changes in mitral deformation were found to independently correlate with exercise-induced changes in ERO (generalized r(2)=0.80, P<0.0001). CONCLUSION: Exercise-induced changes in severity of ischaemic MR in patients with LV dysfunction due to prior MI were independently related to changes in mitral deformation.

Echocardiography, Stress↗
PubMed2005

Significance of recurrences of new atrial fibrillation in acute myocardial infarction.

BACKGROUND: Although new-onset atrial fibrillation (AF) frequently recurs following the acute myocardial infarction, the significance of AF recurrences is unknown. OBJECTIVE: The objective of the present study was to evaluate the incidence, clinical predictors and prognostic significance of AF recurrences following the acute myocardial infarction. METHODS AND RESULTS: A total of 320 consecutive patients with AF following the acute myocardial infarction were evaluated and the patients with AF recurrences were compared to those with single episodes of AF in whom AF did not recur after restoration of sinus rhythm. The incidence of AF recurrences was 22.5%. AF recurrences were highly associated with congestive heart failure and worse Killip class was identified as the most important predictor of AF recurrences. Patients with AF recurrences had poorer outcome, including higher in-hospital (36.1% versus 12.9%) and 7-year (68.2% versus 48.6%) mortality. After multivariate adjustment, AF recurrence remained an independent predictor of in-hospital [odds ratio (OR) = 3.08, 95% confidence interval (CI), 1.45-6.53, p = 0.001], and 7-year [relative risk (RR) = 1.52, 95% CI, 1.00-2.31, p = 0.026] mortality. CONCLUSION: New-onset AF frequently recurs following the acute myocardial infarction and our analysis demonstrated that recurrences of AF independently predicted in-hospital and long-term mortality.

Aged↗
PubMed2005

Somatic DNA damage in interventional cardiologists: a case-control study.

Interventional cardiologists who work in cardiac catheterization laboratories are exposed to low doses of ionizing radiation that could pose a health hazard. DNA damage is considered to be the main initiating event by which radiation damage to cells results in development of cancer and hereditary disease. The aim of the present study was to assess the effects of chronic low-dose X-ray radiation exposure on somatic DNA damage of interventional cardiologists working in high-volume cardiac catheterization laboratories. For this analysis, we used peripheral lymphocytes and the assay for micronuclei (MNs), which is considered to be a reliable biological dosimeter for radiation exposure. We obtained peripheral blood from 62 physicians (mean age+/-se = 40.6+/-1.5 years): 31 interventional cardiologists (group I, exposed) and 31 age- and sex-matched clinical cardiologists (group II, nonexposed). Interventional cardiologists showed higher MN values (group I=20.5+/-1.6 vs. group II=12.8+/-1.3, P=0.001), although some overlap was apparent in the individual subject analysis. A correlation between years of professional activity and MN frequency value was detectable for interventional cardiologists (r=0.428, P=0.02) but not for clinical cardiologists (r=0.253, P=0.17). The results indicated that, overall, interventional cardiologists working in a high-volume catheterization laboratory have higher levels of somatic DNA damage when compared with clinical cardiologists working outside the catheterization laboratory. The amount of this damage varies and is only weakly related to the duration of professional exposure, which suggests that a dominant modulation of the underlying genetic substrate by environmental factors has a role in determining the harm in individual physicians.

Adult↗
PubMed2005

Dipyridamole-dobutamine stress echocardiography for the detection of myocardial ischemia in patients with hypertension.

PURPOSE: To assess the value of dipyridamole-dobutamine stress echocardiography test (Dip-Dob SET) in detecting myocardial ischemia in hypertensive patients with chest pain and to compare it with the results of the dipyridamole-atropine stress echocardiography test (Dip-Atro SET). PATIENTS AND METHODS: 127 consecutive hypertensives with chest pain (82 male, mean age 54.5+/-7.9 years) and nondiagnostic exercise stress test were evaluated. Patients were randomly assigned to receive dobutamine 5-40 microg/kg/min (Dip-Dob group, 55 patients) or atropine 0.25 mg in four divided doses up to 1 mg (Dip-Atro group, 72 patients), if high Dip SET was negative (Dip up to 0.84 mg/kg over 10 min). 84 patients underwent coronary angiography (42 in the Dip-Atro and 42 in the Dip-Dob group). RESULTS: 76 tests were positive for new dyssynergy (16 segment/4-grade model of wall motion analysis), 39 in the Dip-Atro and 37 in the Dip-Dob group, 42 were negative, and nine were stopped due to non-life-threatening side effects, four in the Dip-Atro and five in the Dip-Dob group. Delta wall motion score index (WMSI) was significantly higher in the Dip-Dob than the Dip-Atro group (0.34+/-0.3 vs. 0.21+/-0.4; p<0.01). Coronary artery disease (>or= 50% diameter stenosis) was found in 56/84 patients, 30 patients had multivessel disease (14 in the Dip-Atro and 16 in the Dip-Dob group; p>0.05). Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value were 92.9%, 78.6%, 88.1%, 89.7%, and 84.6% versus 89.3%, 92.9%, 90.5%, 96.2%, and 81.2% (p>0.05, Dip-Dob vs. Dip-Atro). CONCLUSION: There was no significant difference in feasibility, safety and diagnostic accuracy between the Dip-Dob and Dip-Atro test. The Dip-Dob test showed more pronounced ability to provoke myocardial ischemia than the Dip-Atro test, expressed as a higher delta WMSI. Both tests confirmed high diagnostic accuracy of pharmacological stress echocardiography in hypertensive patients.

Dipyridamole↗
PubMed2005

Predictive value of biphasic response during dipyridamole echocardiography test in the low-risk group of patients after acute myocardial infarction.

To investigate whether biphasic response during dipyridamole echocardiography test (DET), which represents viable but potentially ischemic myocardium in the infarcted region, affects prognosis of patients after uncomplicated acute myocardial infarction, we performed high-dose DET in 80 consecutive patients younger than 65 years with first acute myocardial infarction and preserved left ventricular function. Patients were followed up for 27 +/- 12 months for new coronary events. According to DET results all patients were classified into 4 groups: group 1 consisted of 20 patients with biphasic response; group 2 included 14 patients with sustained improvement in regional contractility; group 3 consisted of 24 patients showing no change in contractility; and group 4 included 22 patients with worsening response. Cumulative survival free of total coronary events was significantly lower in group 1 patients compared with all other groups (P < .05). By multivariate Cox analysis biphasic response was the strongest independent predictor of stable angina pectoris (odds ratio = 12.1, P = .0002), followed by hyperlipoproteinemia (odds ratio = 5.9, P = .006). On the other hand, development of acute coronary syndromes could not have been predicted by actual clinical or DET parameters.

Dipyridamole↗
PubMed2005

Prognostic significance of new atrial fibrillation and its relation to heart failure following acute myocardial infarction.

BACKGROUND: New-onset atrial fibrillation (AF) after acute myocardial infarction (AMI) frequently occurs in association with postinfarction complications, particularly with heart failure (HF). AIMS: To evaluate whether postinfarction HF is associated with the subsequent development of AF and whether AF independently predicts poorer prognosis. METHODS AND RESULTS: We examined 650 patients with AMI and compared patients with AF (n=320) to those without (n=330). AF patients were classified as either early AF (n=208)-patients who developed AF within 24 h of symptom onset or late AF (n=112)-patients who had AF thereafter. We compared outcomes between these groups, adjusting for differences in baseline characteristics and postinfarction HF. Heart failure was the most important predictor of AF. In most patients, AF occurred secondary to HF. AF patients had poorer outcomes, including higher in-hospital and 7-year mortality. After multivariate adjustment, overall, AF was not an independent predictor of in-hospital [odds ratio (OR)=0.70) and 7-year [relative risk (RR)=1.14] mortality, but late AF remained an independent predictor of 7-year (RR=2.48, 95% confidence interval, 1.26-4.87) mortality. CONCLUSIONS: Heart failure mostly preceded the occurrence of new-onset atrial fibrillation after acute myocardial infarction, but only late atrial fibrillation was independently related to long-term mortality.

Aged↗
PubMed2004

Adjunctive effect of hyperbaric oxygen treatment after thrombolysis on left ventricular function in patients with acute myocardial infarction.

BACKGROUND: The role of hyperbaric oxygen in patients with acute myocardial infarction is controversial, ranging from not beneficial to having a favorable effect. This randomized study was conducted to further assess the benefit of hyperbaric oxygen treatment after thrombolysis on left ventricular function and remodeling in patients with acute myocardial infarction. METHODS: Seventy-four consecutive patients with first acute myocardial infarction were randomly assigned to treatment with hyperbaric oxygen treatment combined with streptokinase (HBO+) or streptokinase alone (HBO-). RESULTS: There was a significant decrease of end-systolic volume index from the first day to the third week in HBO+ patients compared with HBO- patients (from 30.40 to 28.18 vs from 30.89 to 36.68 mL/m2, P <.05) accompanied with no changes of end-diastolic volume index in HBO+ compared with increased values in HBO- (from 55.68 to 55.10 vs from 55.87 to 63.82 mL/m2, P <.05). Ejection fraction significantly improved in the HBO+ group and decreased in the HBO- group of patients after 3 weeks of acute myocardial infarction (from 46.27% to 50.81% vs from 45.54% to 44.05 %, P <.05). CONCLUSIONS: Adjunctive hyperbaric oxygen therapy after thrombolysis in acute myocardial infarction has a favorable effect on left ventricular systolic function and the remodeling process.

Combined Modality Therapy↗
PubMed2003

Low-dose adenosine stress echocardiography: detection of myocardial viability.

OBJECTIVE: The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability. BACKGROUND: Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine. METHODS: Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100, 110 mcg/kg/min in 3 minutes intervals) echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of >or= 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 +/- 2 months) were available in 24 revascularized patients. RESULTS: Wall motion score index improved from rest 1.55 +/- 0.30 to 1.33 +/- 0.26 at low-dose adenosine (p < 0.001). Of the 257 segments with baseline dyssynergy, adenosine echocardiography identified 122 segments as positive for viability, and 135 as necrotic since no improvement of systolic thickening was observed. Follow-up wall motion score index was 1.31 +/- 0.30 (p < 0.001 vs. rest). The sensitivity of adenosine echo test for identification of viable segments was 87%, while specificity was 95%, and diagnostic accuracy 90%. Positive and negative predictive values were 97% and 80%, respectively. CONCLUSION: Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability.

Adenosine↗
PubMed2002

Treatment of medically uncontrolled coronary artery spasm in the normal coronary artery with coronary stenting.

We present a 53-year-old male with recurrent episodes of vasospastic angina and serious complications of coronary artery spasm including ventricular fibrillation and myocardial infarction, who was treated with coronary stenting at the site of ergonovine-induced coronary vasospasm where the coronary artery appeared angiographically normal, i.e., without evidence of atherosclerotic lesion.

Cardiovascular Agents↗